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Xerostomia, thirst, sodium gradient and inter-dialytic weight gain in hemodialysis diabetic vs. non-diabetic patients.
Med Oral Patol Oral Cir Bucal. 2018 Jul 01; 23(4):e406-e412.MO

Abstract

BACKGROUND

In hemodialysis (HD) patients, xerostomia and hyposalivation may intensify sensations of thirst, and contribute to the intake of fluids and excessive inter-dialytic weight gain (IWG). Since IWG is regarded to be higher in diabetic patients than in non-diabetics HD enhancing their mortality, it is crucial to define plausible underlying causes. Therefore, the study investigates factors contributing to the increased IWG in diabetic HD patients.

MATERIAL AND METHODS

The study included 97 HD patients (38 diabetics) receiving hemodialysis. All participants completed surveys comprising the Dialysis Thirst Inventory (DTI) and Xerostomia Inventory. Unstimulated whole saliva flow rate (USWFR) was measured, with USWFR below 0.1 mL/min being regarded as hyposalivation. Additionally, pre- and post-dialysis serum sodium concentration, sodium gradient and IWG were assessed. In diabetic HD patients, hemoglobin A1c (HbA1c) level was measured.

RESULTS

Significantly higher scores were found in diabetic than non-diabetic HD patients with regard to DTI (21.2±7.7 vs. 17.1±6.2: Z=2.44, p=0.03) and xerostomia (40.5±6.1 vs. 29.9±14.4: Z=4.15, p=0.003). Hyposalivation was observed more often in diabetic HD patients (Z=2.23, p=0.04). IGW was significantly higher in participants with diabetes (Z=2.44, p=0.03), as was the pre-dialysis sodium serum (Z=3.4, p=0.008). High levels of HbA1c were associated with lower levels of serum sodium (r=-0.67 p<0.05). HbA1c positively correlated with pre-dialysis sodium gradient (r=0.66 p<0.05). However, multiple regression analysis found that the only predictors of increased IWG (>4.8 IWG%) in diabetic patients remained saliva flow rate and pre-dialysis sodium gradient.

CONCLUSIONS

Concomitant diabetes in hemodialysis patients appears to intensify subjective xerostomia and thirst sensation. It also leads to excessive IWG by the increase of pre-dialysis serum sodium gradient.

Authors+Show Affiliations

Department of Pediatric Dentistry Medical University of Lodz, Poland 92-213 Lodz, Pomorska 251, agnieszka.bruzda-zwiech@umed.lodz.pl.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29924756

Citation

Bruzda-Zwiech, A, et al. "Xerostomia, Thirst, Sodium Gradient and Inter-dialytic Weight Gain in Hemodialysis Diabetic Vs. Non-diabetic Patients." Medicina Oral, Patologia Oral Y Cirugia Bucal, vol. 23, no. 4, 2018, pp. e406-e412.
Bruzda-Zwiech A, Szczepańska J, Zwiech R. Xerostomia, thirst, sodium gradient and inter-dialytic weight gain in hemodialysis diabetic vs. non-diabetic patients. Med Oral Patol Oral Cir Bucal. 2018;23(4):e406-e412.
Bruzda-Zwiech, A., Szczepańska, J., & Zwiech, R. (2018). Xerostomia, thirst, sodium gradient and inter-dialytic weight gain in hemodialysis diabetic vs. non-diabetic patients. Medicina Oral, Patologia Oral Y Cirugia Bucal, 23(4), e406-e412. https://doi.org/10.4317/medoral.22294
Bruzda-Zwiech A, Szczepańska J, Zwiech R. Xerostomia, Thirst, Sodium Gradient and Inter-dialytic Weight Gain in Hemodialysis Diabetic Vs. Non-diabetic Patients. Med Oral Patol Oral Cir Bucal. 2018 Jul 1;23(4):e406-e412. PubMed PMID: 29924756.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Xerostomia, thirst, sodium gradient and inter-dialytic weight gain in hemodialysis diabetic vs. non-diabetic patients. AU - Bruzda-Zwiech,A, AU - Szczepańska,J, AU - Zwiech,R, Y1 - 2018/07/01/ PY - 2017/11/23/received PY - 2018/04/23/accepted PY - 2018/6/21/pubmed PY - 2019/3/2/medline PY - 2018/6/21/entrez SP - e406 EP - e412 JF - Medicina oral, patologia oral y cirugia bucal JO - Med Oral Patol Oral Cir Bucal VL - 23 IS - 4 N2 - BACKGROUND: In hemodialysis (HD) patients, xerostomia and hyposalivation may intensify sensations of thirst, and contribute to the intake of fluids and excessive inter-dialytic weight gain (IWG). Since IWG is regarded to be higher in diabetic patients than in non-diabetics HD enhancing their mortality, it is crucial to define plausible underlying causes. Therefore, the study investigates factors contributing to the increased IWG in diabetic HD patients. MATERIAL AND METHODS: The study included 97 HD patients (38 diabetics) receiving hemodialysis. All participants completed surveys comprising the Dialysis Thirst Inventory (DTI) and Xerostomia Inventory. Unstimulated whole saliva flow rate (USWFR) was measured, with USWFR below 0.1 mL/min being regarded as hyposalivation. Additionally, pre- and post-dialysis serum sodium concentration, sodium gradient and IWG were assessed. In diabetic HD patients, hemoglobin A1c (HbA1c) level was measured. RESULTS: Significantly higher scores were found in diabetic than non-diabetic HD patients with regard to DTI (21.2±7.7 vs. 17.1±6.2: Z=2.44, p=0.03) and xerostomia (40.5±6.1 vs. 29.9±14.4: Z=4.15, p=0.003). Hyposalivation was observed more often in diabetic HD patients (Z=2.23, p=0.04). IGW was significantly higher in participants with diabetes (Z=2.44, p=0.03), as was the pre-dialysis sodium serum (Z=3.4, p=0.008). High levels of HbA1c were associated with lower levels of serum sodium (r=-0.67 p<0.05). HbA1c positively correlated with pre-dialysis sodium gradient (r=0.66 p<0.05). However, multiple regression analysis found that the only predictors of increased IWG (>4.8 IWG%) in diabetic patients remained saliva flow rate and pre-dialysis sodium gradient. CONCLUSIONS: Concomitant diabetes in hemodialysis patients appears to intensify subjective xerostomia and thirst sensation. It also leads to excessive IWG by the increase of pre-dialysis serum sodium gradient. SN - 1698-6946 UR - https://www.unboundmedicine.com/medline/citation/29924756/Xerostomia_thirst_sodium_gradient_and_inter_dialytic_weight_gain_in_hemodialysis_diabetic_vs__non_diabetic_patients_ DB - PRIME DP - Unbound Medicine ER -